Depression – Symptoms, Treatment & Self Help

What is depression?

Despite an amazing ability to make so many others happy Robin Williams struggled with depression

Depression is a term used quite frequently in day-to-day conversation to describe low mood. Often it’s used by people following a “bad week,” “a job loss,” or a “failing relationship.” Life is full of pitfalls and anxieties and it’s easy to see how we can become ‘depressed’ momentarily after these setbacks. The real difficulty is when this low mood (or other symptoms) fails to lift after a number of weeks, or months. It is the persistence of these symptoms for at least a number of weeks that leads most people to a clinical diagnosis of depression.

What are the symptoms of depression?

Although many psychotherapists do not engage directly with a diagnostic manual for mental illness the medical definition can be useful. It can help people to recognise some signs and symptoms of distress that lead them to seek professional help. The following is a list of common symptoms of depression. It’s not usual to have all of them but several can develop together; varying in intensity from mild to extreme. Additionally, the presentation of these symptoms tend to manifest themselves in a different manner from one person to the next. E.g. one person’s poor concentration may be attributed to “not being able to think about anything except…,” while another person may experience poor concentration as a general malaise with no specific target. These subtitles and unique variations in people’s experience of depression mean that everyone’s experience of depression is different.

● Low mood for most of the day
● Loss of enjoyment or interest in life and even in activities that you normally enjoy
● Feelings of worthlessness and guilt
● Intense feelings of sadness, melancholy and hopelessness
● Lack of energy. Fatigue
● Anxiety
● Poor motivation
● Poor concentration
● Sleeping problems. Not being able to get to sleep and waking frequently. Nightmares
● Difficulty with affection and lack of interest in sex
● Food. Poor appetite followed by weight loss, or alternatively binge eating and weight gain
● Increased irritability, restlessness and agitation
● Physical symptoms. Headaches, chest pain, bodily aches and pains
● Suicidal thoughts. Feeling like “life is not worth living”
● Preoccupation with death and feelings of imminent doom

Winston Churchill famously referred to his depression as a “black dog” that followed him

What causes depression?

No single universal cause of depression has been found. What seems to cause depression in one person might have the slightest affect on another. At times the triggering of a depression can appear deceptively straight-forward. Some people may suffer the death of a loved one, a redundancy, or an illness for example. However, locating what has tipped a momentary depression in to a longer lasting ‘clinical depression’ is not so simple. Multiple factors play a part in sustaining depression and combine in a way that is largely hidden. E.g. one person’s postnatal depression may result from a mixture of biological, and hormonal responses but also deeply buried psychological issues concerning motherhood. It is also evident that some people are more susceptible to bouts of depression than others. There is also a huge variance in the pace at which depression develops from one person to the next. With all of these variables unique from person-to-person it is possible to say that the cause of depression is individual to everyone.

Who gets depression?

Princess Diana suffered with depression and bulimia

Depression is one of the most common mental illnesses reported in Ireland. It is estimated that at any one time 7% of the population are suffering with depression. Although diagnoses of depression are higher in women, teenagers, elderly and single people this does not tell the full story. It may be the case that these populations are merely the most likely to report depression, rather than most likely to become depressed. Either way, the truth is that anyone can suffer with depression.

Treatment of depression

Psychoanalytic psychotherapy is a longer-term therapy that aims to uncover underlying issues at play in depression, and other mental illness. Studies of the psychoanalytic approach have found it to be “superior” in outcome and lasting effect in comparison to CBT and other short term treatments (Leichsenring, & Rabung, 2008). The reason for this efficacy is believed to be associated to the therapy’s ability to better handle complex material. (Leichsenring, & Rabung, 2011). Weekly sessions of psychoanalytic psychotherapy generally continue for a minimum of several months which may sound daunting at first. However, a strong case can be made that the initial financial and time investment eventually pays for itself tenfold, not least in terms of peace of mind.

2. Medication

In Ireland medication tends to be the first port of call due to the ease at which antidepressants can be administered. However, this does not necessarily mean medication is the most effective or beneficial treatment. Treatment through medication can help stabilise a person’s biology but it leaves the psychological aspect of depression largely ignored. Much like placing a plaster over a wound, medication can help to mask the problem but does not treat the issue directly. In very threatening cases of depression where suicidal thoughts are quite prevalent it is advised to seek help from a GP in combination with psychotherapy.

3. Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a short-term therapy that aims to modify thinking patterns. Although it has been found to have good results initially in depressed people these are not lasting effects. Studies have shown that there is “no guarantee of good outcomes over the longer term” following CBT (Durham et al., 2005). The reason for this poor efficacy over long-periods is that CBT can often ignore the complexity of underlying issues at play in depression, and other mental illnesses (DeRubeis et al., 1999).

“I thought I was a huge failure” – Marlon Brando’s self criticism coincided with his battle against depression

Self-help for depression

When depressed it’s common to feel helpless but it is important to remember there are things that we can do to immediately fight depression. Broadly speaking there are two streams of action that we can take; biological and psychological. While influencing our biology can have positive effects it is recommended that we pay closer attention to psychological factors.

1. Psychological Actions

● Talk to someone. Call a friend or talk to a family member if only about menial things
● Talk about your problem. Find someone you can trust and speak about your problems
● Pets. Playing with pets and taking animals for a walk can help
● Write about your problem. Poem, prose, song, diary – it all helps
● Hobbies & Activities. This can be a great way to meet new people
● Seek help from a psychoanalytic psychotherapist

One of the world’s most famous astronaughts, Buzz Aldrin, was plagued by depression before eventually beating it and becoming chairman of the National Mental Health Association, USA

1. Biological Actions

● Go outside. Walk to the shop, take the bus somewhere different
● Exercise. Studies have shown that exercise can be as effective as antidepressants
● Diet. Reduce intake of alcohol and sugary snacks. Eat more vegetables and fruit
● Sleep. Aim to get 8 hours of sleep a day
● Sunshine. Try to expose ourselves to natural sunshine daily
● See a GP. If the intensity of depression continues or becomes overwhelming it may be important to see a GP

Some Do’s and Don’ts

● Get help from a professional therapist
● Do speak to a trusted family member, friend or colleague
● Do visit a friend
● Do realise that even the world’s most successful people have suffered with depression
● Do try to partake in activities/hobbies/exercise
● Do maintain a schedule (include sleep)
● Do eat regularly and healthily
● Don’t think that you are alone
● Don’t suffer in silence
● Don’t be afraid to ask for help

Colin McDonnell is a psychoanalytic psychotherapist with over ten years experience working in different health and social settings. Currently he works as a psychoanalyst and Clinic Director at Psychotherapy Dublin. As an accredited psychoanalytic psychotherapist he is a member of APPI, ICP, PSI and PPS. He also holds masters degrees in both psychoanalytic psychotherapy and addiction studies.